Scand J Trauma Resus
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Scand J Trauma Resus · Feb 2017
Pre-hospital transfusion of packed red blood cells in 147 patients from a UK helicopter emergency medical service.
Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. ⋯ Pre-hospital PRBC transfusion significantly reduces the time to transfusion for major trauma patients with suspected major haemorrhage. The majority of patients receiving pre-hospital PRBC were severely injured and required further transfusion in hospital. Further research is warranted to determine which patients are most likely to have outcome benefit from pre-hospital blood products and what triggers should be used for pre-hospital transfusion.
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Scand J Trauma Resus · Feb 2017
Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic.
The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. ⋯ Both primary missed diagnosis and diagnostic error have relatively low prevalence but have a serious impact on patients, hospitals and medical services. Planned follow up after adequate explanation can help to prevent diagnostic error and detect primary missed diagnosis, thereby reducing time to final diagnosis and risks for medico legal litigation. Reassessment of diagnostic error on a timely basis can be used as a key performance indicator in a quality assessment program.
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Scand J Trauma Resus · Feb 2017
Thrombocytopenia on the first day of emergency department visit predicts higher risk of acute kidney injury among elderly patients.
Few studies have addressed risk factors for acute kidney injury (AKI) in geriatric patients. We investigated whether thrombocytopenia was a risk factor for AKI in geriatric patients with medical illnesses. ⋯ Thrombocytopenia on initial presentation might indicate an increased risk of AKI among elderly patients with medical illnesses.
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Scand J Trauma Resus · Feb 2017
Severity-dependent differences in early management of thoracic trauma in severely injured patients - Analysis based on the TraumaRegister DGU®.
Major trauma is associated with chest injuries in nearly 50% of multiple injuries. Thoracic trauma is a relevant source of comorbidity throughout the period of multiply-injured patient care and may require swift and well-thought-out interventions in order to avert a deleterious outcome. In this epidemiological study we seek to characterize groups of different thoracic trauma severity in severely injured patients and identify related differences in prehospital and early clinical management. This may help to anticipate necessary treatment for chest injuries. ⋯ We provide epidemiological data on trauma mechanism, concomitant injuries, frequencies of emergency interventions and outcome associated with different thoracic trauma severity. Prehospital and early clinical management is more complex when AISThorax is ≥ 4. Severely injured patients with critical thoracic trauma are most challenging to take care of with highest rates in prehospital intubation, cardiopulmonary resuscitation, chest tube placements, blood transfusions as well as emergency surgery.
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Scand J Trauma Resus · Feb 2017
ReviewRecognition of out-of-hospital cardiac arrest during emergency calls - a systematic review of observational studies.
The medical dispatcher plays an essential role as part of the first link in the Chain of Survival, by recognising the out-of-hospital cardiac arrest (OHCA) during the emergency call, dispatching the appropriate first responder or emergency medical services response, performing dispatcher assisted cardiopulmonary resuscitation, and referring to the nearest automated external defibrillator. The objective of this systematic review was to evaluate and compare studies reporting recognition of OHCA patients during emergency calls. ⋯ Among the 16 included studies, we found a median sensitivity for OHCA recognition of 73.9% (range: 14.1-96.9%). However, great heterogeneity between study populations and in the definition of "recognised OHCA", lead to insufficient comparability of results. Uniform and transparent reporting is required to ensure comparability and development towards best practice.